SAN FRANCISCO — The Ninth U.S. Circuit Court of Appeals has ruled against an inmate who sued the state for damages for denial of health care. Though the 11-judge court was divided, the majority defended their position on the grounds that the state has failed to provide enough funding for both medical staff and supplies.

According to a court summary, inmate Cion Peralta, the defendant, requested dental care just days after being incarcerated, citing pain, cavities and bleeding gums. Though he was able to see a dentist sporadically, he was kept on the facility’s non-emergency care list for 18 months. During that time, he developed periodontitis and severe bone loss. Peralta then sued his dentist, as well as the prison’s chief medical and dental officials.

At the time Peralta arrived at the California State Prison in Los Angeles County the prison had only three or four dentists, three or four dental assistants, and no office technicians or dental hygienists. Though state policy calls for one dentist for every 950 prisoners, the ratio was closer to one to 1,500. In addition, the dentists there were responsible for roughly 1,800 inmates at other facilities, bringing the ratio to around one to 2,000.

Despite Peralta’s protests, the court held that a prison official sued for money damages may raise a lack of available resources as a defense. Chief Judge Alex Kozinski sided with the state-employed dental staff. "A prison medical official who fails to provide needed treatment because he lacks the necessary resources can hardly be said to have intended to punish the inmate," said Judge Kozinski in the majority opinion. The judge added that inmates can continue to sue the state on the basis of health care denial, but must prove that the employees in question were “deliberately indifferent” to that inmate’s needs and requests.

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Meanwhile Judge Morgen Christen authored a response of partial concurrence and partial dissent. Judge Christen, joined by four fellow judges, stated that, “the decision overturned more than thirty years of circuit precedent by holding that lack of resources is a defense to providing constitutionally inadequate care for prisoners.”

Judge Morgen also countered that the decision did not serve inmates who had already suffered from delayed medical care. “What good is (a treatment order) to a prisoner whose appendix has burst?" asked Morgen. "Without the ability to seek damages, prisoners who sustain injuries from overcrowding and underfunding will be denied any meaningful form of relief, and the state will have little incentive to improve conditions.”

In his own partial concurrence and partial dissent statement, Judge Andrew D. Hurwitz added, “The majority effectively holds that a state can first choose to underfund the medical treatment of its wards, and then excuse the Eighth Amendment violations caused by the underfunding. Today’s decision thus not only forecloses relief to inmates who suffer cruel and unusual punishment, but also encourages future constitutional violations.”